Opioid analgesics increase incidence of somnolence and dizziness as adverse effects of pregabalin: a retrospective study

Abstract

BackgroundPregabalin, a gabapentinoid, is an adjuvant analgesic for treatment of neuropathic pain, but it has serious adverse effects such as somnolence and dizziness, particularly in elderly patients. Although decreased renal function is considered to the contributing factor for high frequency of these adverse effects in elder patients, only a few systematic clinical investigations, especially for hospitalized patients, have been performed on factors that might affect the incidence of its adverse effects. In this study, we performed a retrospective study on the effect of concomitant drugs on induction of somnolence and dizziness as adverse effects of pregabalin in hospitalized patients.MethodsThe subjects were all pregabalin-administered patients in Shiga University of Medical Science Hospital from September 2010 to September 2012, and the subject number was 195. Multivariate logistic regression analysis was performed to determine predictors of the adverse effects, creatinine clearance, duration of pregabalin therapy, initial and maintenance doses of pregabalin, and concomitant drugs, including hypoglycemic drugs, anti-hypertensive ones, non-steroidal anti-inflammatory ones, opioids and central nervous system depressants, being used as independent variables.ResultsThe median initial doses of pregabalin in each renal function group were the same with the case of the defined dose. Although renal function is a well-known factor for prediction of development of adverse effects of pregabalin, we did not detect significant contribution of it. Alternatively, it was demonstrated that concomitant administration of opioids was the significant factor of the incidence of somnolence and dizziness. The first onset date of the adverse effects was frequently detected in the early days of the pregabalin therapy.ConclusionsThe fine tuning of pregabalin dosage schedule based on the renal function appeared to be critical for prevention of development of its adverse effects. Adverse effects tended to develop in the initial phase of pregabalin therapy. Concomitant administration of opioids with pregabalin has the potential to increase the incidence of adverse effects, and thus much more careful attention has to be paid especially in those situations.

Perioperative Anxiolytic and Analgesic Effects of Pregabalin in Vitreo-Retinal Surgery: A Randomized, Double-blind Study

“…Our study also showed that the need for postoperative analgesia was more in the placebo group compared to the group receiving pregabalin. This is also congruent with the findings in the literature, where the duration of analgesia was prolonged postoperatively in cohorts administered with pregabalin (23,24).…”

Comparison of Pregabalin and Ketotifen in treatment of uremic pruritus in hemodialysis patients

“…So, to use high doses of Pregabalin, we used stricter restrictions on patient selection. In most studies, such as ours, dizziness has been the most common complication 4,8–11 . In our study, there is no considerable side effects in both groups.…”

“…Otsuka et al indicated that a maximum dose of 150 mg of Pregabalin in dialysis patients has no serious side effects 9 . Different studies showed that Pregabalin has more complications in elderly patients, opium users, dialysis patients with underlying disease 10,11 . So, to use high doses of Pregabalin, we used stricter restrictions on patient selection.…”

Switching From Pregabalin to Mirogabalin in Patients with Peripheral Neuropathic Pain: A Multi-Center, Prospective, Single-Arm, Open-Label Study (MIROP Study)

“…In healthy individuals, concomitant tramadol had little effect on the pharmacokinetics of mirogabalin, nor did it affect the incidences of somnolence or dizziness [17]. In clinical situations, the incidences of somnolence and dizziness have been shown to be higher when pregabalin was used in combination with opioids such as tramadol [18]. Further studies are needed regarding the combined use of these drugs in clinical practice.…”